Healthcare Provider Details

I. General information

NPI: 1932066099
Provider Name (Legal Business Name): NATALIE AUTUMN WILSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7985 E 16TH AVE STE 100
ANCHORAGE AK
99504-2896
US

IV. Provider business mailing address

3375 CHECKMATE DR
ANCHORAGE AK
99508-4923
US

V. Phone/Fax

Practice location:
  • Phone: 907-373-9764
  • Fax:
Mailing address:
  • Phone: 907-444-8469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number184460
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: